HIV outcomes among women living with HIV who experienced early sexual violence across four sub-Saharan African countries

Early experiences of sexual violence may influence HIV care and treatment outcomes among women living with HIV (WLHIV). We examined whether self-report by WLHIV of being forced into their first sexual experience was associated with awareness of HIV-positive status, being on antiretroviral therapy (ART) and being virologically suppressed. We conducted a secondary analysis using nationally-representative, cross-sectional Population-based HIV Impact Assessment (PHIA) surveys from Lesotho, Malawi, Zambia, and Zimbabwe conducted from 2015 through 2017. Adjusted logistic regression models with survey weights and Taylor series linearization were used to measure the association between forced first sex and three HIV outcomes: (1) knowledge of HIV status among all WLHIV, (2) being on ART among WLHIV with known status, and (3) virologic suppression among WLHIV on ART. Among WLHIV, 13.9% reported forced first sex. Odds of knowledge of HIV status were not different for WLHIV with forced first sex compared to those without (adjusted odds ratio (aOR) 1.17; 95% CI: 0.95-1.45). WLHIV with forced first sex had significantly lower odds of being on ART (aOR 0.74, 95% CI: 0.57-0.96) but did not have lower odds of virological suppression (aOR 1.06, 95% CI: 0.80-1.42) compared to WLHIV without forced first sex. While high proportions of WLHIV were on ART, report of non-consensual first sex was associated with lower likelihood of being on ART which may suggest that early life trauma could influence long term health outcomes.